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General NPI Number Information
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NPI Number | 1114447083
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Entity Type | Organization
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Legal Business Name | THE MCINNIS CLINIC PLLC
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Dates
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Enumeration Date | 06/22/2017
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 1123 S MAIN ST STE C
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City | REIDSVILLE
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State | NC
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Zip | 27320-5340
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Country | US
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Telephone | 336-342-4286
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Fax | 866-258-0126
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Provider Business Mailing Address
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Address Line | 1123 S MAIN ST STE C
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City | REIDSVILLE
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State | NC
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Zip | 27320-5340
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Country | US
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Telephone | 336-342-4286
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Fax | 866-258-0126
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CESAR N KALOMBO
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Credential | DNP, AGNP
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Telephone | 336-342-4286
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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